Bridging the gap: empowering community Health workers using mobile technology

A word can carry a connotative or denotative meaning. For starters, denotation refers to the literal meaning of a word, the “dictionary definition.” Connotation, on the other hand, refers to the associations that are connected to a certain word or the emotional suggestions related to that word. For example, to many people, you and I included, a mobile phone, whether an ordinary phone or smart phone is simply a communication gadget but to 35 noble men and women in Mwingi, a phone is more than a communication gadget it is an educational tool that is transforming and saving lives in Mwingi West, it is a health solution, thanks to Amref and partners.

Since 2012, Amref and partners such as Accenture, Safaricom, Mezzanine and the Ministry of Health focused on empowering Community Health Workers through the use of mobile technologies to provide continued learning opportunities and access to information- as cliché as it may sound, information is power!

world over, there is a sharp shortage of health workers. A report released in November 2013 by the World Health Organization called A Universal Truth:No Health without a Workforce estimates that the world will be short of 12.9 million healthcare workers by 2035! Today, that figure stands at an alarming 7.2 million!

A closer look at Mwingi district as at March 2014 for example, one doctor is in charge of a massive 50,000 patients! In Kakululo Dispensary in Mwingi County, one of the areas where the project is being piloted, a single nurse is in charge of whooping 5,000 patients! To bridge this gap Community Health Volunteers are desperately needed but now the limitation is the capacity to train them so that they may confidently volunteer their services to their communities.

That is why concerned stakeholders including governments, International Non-governmental Organizations, Multinationals etc must move with speed to rethink and improve how to teach, train, deploy, and pay health workers so that their impact can widen.

Generally, mobile phone usage in Africa is booming and a large number of people own a mobile phone. The increasing penetration of mobile phones in Kenya for example has led to a rise in SMS-based information dissemination services. Amref and partners took advantage of this opportunity to empower Community Health Workers through use of mobile technologies to provide continued learning opportunities and access to information through Health Enablement and Learning Platform (HELP). This in turn equips the Community Health Workers with the necessary skills to create lasting health impact.

Mr. Bernard Ngombe, a Community Health Worker demonstrates how he uses his phone to learn.

Mr. Bernard Ngombe, a Community Health Worker demonstrates how he uses his phone to learn

The HELP project is being undertaken in Kibera, Mwingi and Samburu. This areas where carefully selected considering that most  African population are either in a rural setting (like mwingi), a nomadic setting (like Samburu) and if in urban areas, then they are in an informal setting (like Kibera).

As a norm and expected standards, a community health worker should have a 10-day face to face training and then released to the community to start working (volunteering)! But the model adopted by Amref and partners reduces the amount of face to face training by three while increasing knowledge retention and promoting continuous learning.

This model has features that allows the community health worker to learn through lectures and role plays, there is a group chat feature that allows them to communicate with each other; the job aide feature gives the community health workers instructions on how to use various basic tools of trade and lastly, the health decision tree feature that supports real-time diagnosis of prevalent diseases within the community.

What melts my heart about the HELP project is the way mobile devices allow health workers to access information without the limitations of cost as it is absolutely free and the health worker can also learn in his/ her own time and pace.

Some of the Community Health Workers in Mwingi

Some of the Community Health Workers in Mwingi

This noble initiative by Amref makes me deeply reflect on what Prof. Mahmoud Fathalla known to be ‘the father of maternal health’ said “Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving.” Having noble men and women who have committed to donate at least 2 hours of their time daily to volunteer for free as community health workers is in itself a decision to demonstrate that lives are worth saving.

I give a standing ovation to Amref and partners and I hope that soon, very soon I, the ‘self-appointed-maternal-health-advocate will be here again to write on the opening of the beautiful maternity wing of Kakululo Dispensary which will be a step higher in reducing maternal and child mortality-most of which are preventable by ensuring that more women deliver their bundle of joy in a health facility with the help of a skilled health worker by reducing the barrier of distance.

The newly constructed maternity wing at Kakululo Dispensary in Mwingi

The newly constructed maternity wing at Kakululo Dispensary in Mwingi

By the way I was encouraged that in the month of January and February, 0 maternal and 2 newborn deaths where recorded in this rural ukambani dispensary! This means, there is light at the end of the MDG5 tunnel, as dim as it appears.

Stopping harassment and bullying of pregnant women is a step in improving maternal health!

Last weekend was all about women anyway it is a woman’s world! The weekend which I dubbed ‘women-affairs-weekend’ started with the international women’s day on Saturday and on Sunday, the First Lady Mama Margaret Kenyatta crowned it with the Beyond Zero Campaign marathon which I did not participate for obvious reasons-not beating the deadline (oops!). All in all, I followed the marathon from the comfort of my house and I can say without fear of contradiction, it was successful.

Margaret Kenyatta, thank you so much mum for this initiative because many women will be saved, many mothers will carry their newborn home and many children will celebrate so many birthdays and i agree with you, it is unnecessary for mothers and children to die!

As free maternity and mobile clinics services are slowly by slowly executed, a critical issue needs to be addressed first and fast because it is a step higher in improving maternal health and reducing child mortality maternal health, I believe is not only structural read physical but emotional and psychological as well. This issue is the harassment and bullying of laboring and birthing women! Yes, you have read it right, laboring and birthing women are continuous mistreated, harassed and bullied in our public hospitals!

Remember the story that was highlighted and greatly condemned about the alleged mistreatment of an expectant mother at the Bungoma District Hospital? Well, let me refresh your mind, in September 2013, KTN obtained a video footage of what can only be the worst possible form of patient mistreatment. The video showed a mother forced to deliver on the floor as nurses looked. They then abused and slapped the poor woman for supposedly ‘messing up the floor’. Health officers in the District hospital exposed that poor expectant mother to unhygienic and dangerous environment while delivering a baby and at the same time proceeded to physically assault her shortly after giving birth! Unyama ulioje!

I am a victim of  harassment too. In my last post, I narrated how I lost my son (May his soul rest in peace). After calling my doctor to inform him I was bleeding heavily, he instructed me to go to the nearest hospital because it was dangerous for me and my unborn baby. Kenyatta National Hospital was the nearest facility and after all, all the specialists are found in the facility being the biggest referral hospital and I knew I will be in safe hands there. I went to the emergency section bleeding and in great pain; a pain I cannot wish even to my greatest enemy but amid all that agony, I was received very coldly as if it was my fault and making to develop the complication!

I met a very mean nurse who with a snear, started interrogating me: mama unaitwa nani (What is your name?) how many weeks is your pregnancy? Una bleed kwani ulianguka au mzee alikuchapa? (Are you bleeding because you fell or did your husband clobber you?) Where have you been attending your antenatal? I said ‘Nelson Awori Centre’ ehe, mama, the nurse continued ‘ati private sindio na sasa nini imekuleta casualty leo? Si ungeenda private?’ My mentioning that I have been attending antenatal at a private clinic aggravated her. I was told to lay on a bed that was so high and I did not have the strength since I had lost so much blood and the nurse went again ‘mama, panda hapa haraka wacha ujinga na kama utaki kusaidiwa enda nje, unafikiria wewe ni mgonjwa peke yako? As I was being wheeled to the labour ward, the nurse kept throwing insults after insults because I was attending private clinics and to crown it all, the nurses at the labour ward kept bullying women and openly telling us that president Kenyatta said that women should deliver for free but he did not provide human and financial resources- I went to the hospital on 14th June, just two weeks after the President announced free maternity services in public hospitals. Were it not for my doctor who bulldozed for my transfer to the private wing, maybe, just maybe I could have rested in peace together with my son on Friday, 14th June 2013.

There are so many cases of harassment and bullying of laboring mothers, some of which go unreported. For example, The Standard Newspaper once carried a story in which a reproductive health forum in Kitale town was told that many expectant mothers in rural areas prefer Traditional Birth Attendants (TBAs) to nurses in Government hospitals because nurses in public hospitals and some private clinics mistreat them whenever they visit the facilities for assistance during labour.

“Nurses in Government hospitals hurl insults at pregnant women during labour,” lamented one woman at the meeting that was organized by the Kenya National Commission on Human Rights. The women said they, therefore, shun attending prenatal clinics and instead take herbal medicine prescribed by TBAs in their home areas.

Abuse of laboring and birthing women is a less noticed maternity care problem because as a woman in labour or in a complication-related pain, you are too vulnerable and thirsty for any form of help that you cannot even notice that you are being harassed.

Despite the presence of many caring and supportive physicians and hospital staff, anyone involved with birthing women has heard of or witnessed many examples of verbal and physical abuse directed at women giving birth in hospitals.Although often not recognized as abuse, this behavior toward women, especially in childbirth, is unacceptable and harmful.

The problem of abuse in hospital-based maternity care is neither women’s fault nor a problem of a few individuals who are abusive. It is a systemic problem, enabled by a lack of accountability and a culture of impunity in the hospital hierarchy, where abuse and harassment come from the top down, affecting hospital staff as well as patients. Why do I say this? I asked my doctor why a nurse who should be caring for me and encouraging me amid pains, end up abusing or bullying me and my doctor’s answer was simple, maternity wings at some public hospitals are considered ‘hardship areas’ and a perfect place for punishment! Some of the staff are not there out of passion for maternal health or preference but because of a punishment serving a sentence kind of and therefore, all their frustrations are projected towards the poor woman in labour!

It may be that many hospital staffs, overworked and stressed, are unaware of behaving abusively toward patients. But naming the problem and confronting the behaviour is a first step to improving maternal health instead of keeping quiet and letting them operate in impunity and disregarding human right keeping in mind that, women rights is human rights!

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